Author: CCCSLP

Great Expectations

Great Expectations

By Barbara Yauch

Great Expectations

As a mother of 4 adult children, two boys and twin girls, I have recently had the chance to reflect upon their lives and our life together. I have discovered that each one, in his or her own way turned out just as I had hoped and expected they would – independent, self-sufficient, strong-willed and successful adults.

The path to successful adulthood was not without its bumps in the road.

I recall being a young mother of two boys expecting my third child (a girl?, I’d hoped) . It was the 1960s and the pregnancy was proceeding as expected, until the sixth month, when my water broke. This was unexpected, after all, to this point, everything had proceeded normally, as expected. I believed I would deliver a healthy baby.

My husband and I traveled to the hospital, only to find interns, nurses and even the doctor saying, “very small baby”, “very big baby”, “ too early”, “you will be going home soon”. Each proclamation was wrong, and eventually, 10 weeks before my due date, I delivered not one, but two baby girls – 75 minutes apart. Talk about unexpected!

My husband and I were excited by the news. This was truly the buy-one-get-one deal of a lifetime. However, our excitement and my relief that all that pain of labor was over were short lived, as nurses were heard to say, “This may be your only chance to see your babies!” (They were very small and babies that size, in those days, did not live long). Again, unexpected but also unacceptable. We called our pediatrician and he went into action.

As days turned into weeks, my family and I waited patiently for “the girls” to gain weight, recover from jaundice, and be released from the hospital. That day came 6 weeks later. We all breathed a sigh of relief and brought the girls home. We began to build our lives together raising a healthy happy family of 6, as expected.

All mothers, as they watch their children grow expect that they will hit their growth milestones predictably—roll over, sit up, crawl, stand, walk etc. My sons did, why shouldn’t my daughters? But they didn’t. Being proactive and wanting my children to continue along expected lines of development, to the pediatrician we went. He suggested we see an orthopedist. His diagnosis: Cerebral palsy. Our reaction: Shock. But after the shock: Action. We would not take this lying down. We were educated parents. I had a Masters Degree in Special Education. My girls were going to grow up fine, as expected.

As they grew up, never once did I believe there were things they could not do. We never treated them as disabled children. We never told their brothers or their friends to treat them differently. I/we expected them to be part of an active family. I expected my girls, like my boys, to:

  • Dress themselves. Put on and lace up their own shoes (no matter how long it took). If you have to get up an hour early because it takes you an hour to lace up your shoes, so be it).
  • Walk (assisted or unassisted). The doctors told me my younger twin would never walk with crutches – her right hand was too weak. But she did, and at her sister’s wedding, she walked with a cane!
  • Do their chores.
  • Go to school. Of course I also expected they would go to the same school, which did not happen until their 6th year. ADA, Title 9, PL94-142 did not exist way back then.

Therein began the battle for education rights. Educators believed my daughter, who was in a wheelchair (for long distances) would have to be bused to another city instead of going to the neighborhood school that was within walking distance for her brothers and twin. All she needed was a bathroom with a grab bar in it to succeed, but they said, “No”.

Having little choice at the time, I sent her to that ‘other school’ expecting a good education. When this did not occur, I protested, wrote letters, talked to everyone who would listen until finally, the new superintendent of schools arrived. When I went to talk to him, fully expecting a confrontation, he said, “I don’t see any reason why she can’t come to our schools”.

The girls were back together. Family and community life continued as expected. I expected good grades — which they got. I expected them to participate in all aspects of their education, which they did, becoming involved in student government and theater arts, learning to ride and fall off their bikes, just like their brothers did. Sometimes they fell with their bikes, when we tied their feet to the pedals to keep them from falling off, but each time they got up and started again.

I believed that if my children put their minds to it, there was nothing they could not do. I know to this day they believe that. As their lives went on, each graduated high school with honors (as expected), each went to college, (rival schools) and I’m not sure if the separation was harder on them or me. They graduated from those schools with Masters Degrees, in the same field and are leading independent, productive lives, helping others with special needs.

They were able to do that because of my desire, and their will to be independent. I taught them life skills, which all of us need to make our way in the world. I taught them to be good citizens, to respect others and expect respect in return. I taught them to stand up (literally and figuratively) for themselves and not to let others (even if they are your brothers!) push you down. If they do, get up and push back.

Sometimes I think mothers of those with special needs expect too little of their children because “they aren’t like other children… they can’t do what other children can”.

I don’t believe that. My daughters remember a poem I placed over their beds when they were little that read, “I’m Special”. How true that was. They were special, not for what they could not do, but for what they could. They had lessons to teach us about taking life by storm and not letting anything get in the way of what you want.

I believe every mother should expect great things from all her children, no matter what their abilities. I did and I have never been disappointed.

About the author

Barbara Yauch has a Bachelor’s Degree in Education and a Master’s Degree in Special Education from Wayne State University in Detroit, MI. After teaching children with Special Needs for over 25 years, Barbara retired to southern Florida where she can be found ‘living the dream’ and enjoying the Detroit Tigers Spring Training in person. Contact Barbara at lycslp@gmail.com. .

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R-E-S-P-E-C-T

R-E-S-P-E-C-T

By Lisa Yauch-Cadden

“R-E-S-P-E-C-T”

As someone who grew up in Motown, I know a little bit about Aretha Franklin and her mantra. As a clinician who has been around awhile, I know a lot about why it is so important.

In our business, we deal with all kinds of people: patients, families, physicians, nurses, therapists, case managers, social workers, insurance representatives, students, etc. Like any business that involves personal interaction, everyone has a perspective, an agenda, a point of view. In our role as a diagnostician/therapist, we may need to bring all of these perspectives together, and if we can’t bring them all together, we certainly need to appreciate them. Every person that works with/interacts with our patient has a perspective about that patient, and those perspectives may be important to us. When I evaluate a patient, I always try to ask them what they think the nature of their problem is. I also ask their family members: “What problems do you see?” “Why do you think they are occurring?” I canvas the nurses and the CNAs. I consult with the physician. I ask the treating clinician (CFY, SLP-A) who may be working with them. All of these people invariably know the patient better than I do and their insights are important to me and to the patient. When I come to a conclusion, I let patients/families know, “Here’s what I think”. I seek confirmation, when I can, (e.g., “Does this make sense with what you see at home?”). It provides for a better recommendation, usually leading to one the patient can live with (think: modified diet/thickened liquids).

I also have used this approach as a manager and find that staff generally do a better job when you treat them with respect. I know, novel concept. Having worked for managers that don’t share this philosophy, however, makes me think that this is may not be an intuitive strategy for some people. The concept, however, is simple. People have their own opinions and perspective, as do you, and like you, people think that they are right. As a manager, you need to appreciate that, and sometimes solicit that perspective, in order to come to a shared conclusion. Like you, people need to be validated. Once you let them know that their perspective has value, they are much more likely to hear your side of the story. And when that side doesn’t necessarily agree with theirs, or doesn’t give them what they want, you are less likely to have problems afterward, as long as you’ve told them the truth.

And that’s the second part of the equation: Tell the truth. Respect the person you are dealing with enough to let them know the truth. If they know you are being truthful, even if they don’t like what they are hearing, they are more likely to accept it. Isn’t that how you would like to be treated? Imagine what a world it would be if everyone acted this way.

About the author

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com. .

If you have something to say, please submit your article for consideration to lycslp@gmail.com. .…

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10’s by Lori Yauch

10’s by Lori Yauch

For our inaugeral column, we have selected Lori Yauch, a Speech Language Pathologist of over 20 years, practicing as an independent Consultant/Clinician in the Tampa Bay Area. Lori has a unique product that she would like to share with her colleagues, but in order to do that, she must first answer the 10 ‘no ifs ands or buts’. We hope you enjoy her responses as much as we did.

1. Cookie of choice for bedside swallow exams:

Lorna Doone

2. Preference for language testing BDAE or WAB:

BDAE

3. +/- or PICA for scoring:

Modified PICA (10 down to 1, but I forget what 2 is. I think it’s the same as 6, so why use it? You get more credit with 6, or maybe you just get egg roll. I can’t remember)

4. Muppets or dwarves for entertainment purposes only:

Muppets

4a. Favorite individual muppet or dwarf:

Elmo

5. Worst treatment moment of your career:

Any moment during my first job. I was a new grad and had to move away from home, living truly on my own for the first time. I lived in one state and crossed the border daily to work. My CFY Supervisor was selfish, unsupportive and certainly, ineffective as a teacher. I think it was her mission to find fault in every move I made, both in the clinical arena and in the building environment. I used a scooter to assist in my mobility and was written up for, among other things, the way in which I moved about the facility. By the end of 6 months I resigned. I heard later, she fell and was in a wheelchair for a time. You know what they say about paybacks! I moved on to greater and greener pastures. Years later I am a respected clinician, having supervised many students and CF’s and am here offering insights into our field Things really do have a way of working out.

6. Best advice you ever ignored:

I don’t typically ignore advice. However, there was a time when I was looking for bigger and better things. A friend suggested I come to her company, I considered it carefully and just as I was about to make the decision to move on, the company called and rescinded the offer. As it turned out, better offers came and when the time was right, I moved on.

7. Favorite, most reliable, and practical treatment strategy:

Masko Maneuver

8. Why SLP and not world domination?

SLP is world domination. One patient at a time.

9. Would you do it all over again exactly the same way?

Yes. If I hadn’t, I would not be where I am today. I learned from every experience. What I want and what I don’t. I have a good career balanced with a good life.

10. What one thing do you still want to do before your career goals are completely achieved?

Publish my manuscript. Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity (which segues very nicely into the next question)

SHAMELESS SELF PROMOTION IN 30 WORDS (there actually is no word limit really so say whatever you want):

As clinicians in long-term care or adult rehab settings, we have all been faced with the necessity of providing group activities to our residents/patients. In an effort to come up with a new and innovative group idea, I decided to bring my passion for classic movie musicals and my job together. In conjunction with the Activity Dept. at the skilled nursing facility in Florida, where I was one of 3 speech pathologists, Movies and Music was established. In running this group I began to realize with the right material and right level of function, watching a movie which was once a sedentary activity, could be quite interactive. The interaction fostered increased communication, use of language, pragmatic skills, conversation and long term memory.

With this in mind, together with further observation that no group like this existed in any of the facilities I visited as a consultant, Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity was born.

The guide is divided into 12 sections according to the calendar year and centers on a specific movie for a given holiday in the month (New Year’s Day, President’s Day, St. Patrick’s Day, etc). The films were chosen specifically for their ability to promote interaction.

The group size is generally 4 -10 patients with mild – moderate cognitive impairment. Diagnoses may include: Right/Left Hemisphere CVA, TBI, Dementia, Parkinson’s Disease or any other diagnosis at the Group Leader’s discretion.

Field testing completed during 2008-2009, yielded positive results with clinicians stating:

“ I highly recommend Movies and Music to any clinician working with individuals with mild to severe communication deficits….I look forward to being able to include this in my future plan of care at my facility.” Jane Fitzgerald House, M.S., CCC-SLP

“Assessment of the group dynamics indicated increased motivation, interest and curiosity which resulted in increased expressive language skills. … Group participants stated it was fun and interesting.” Lisa Mathers, M.S., CCC-SLP

Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity is available for purchase. Please contact Lori Yauch at moviemaven1@verizon.net.

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What’s The Frequency (March 2010)

What’s The Frequency (March 2010)

By Marguerite Mullaney

My teammate in this venture does not really appreciate the name of my column. I find that the more she tries to get me to define the title, the more I identify with it. Frequency is, after all, about redundancy of actions within a finite time frame. Language like life itself is based on the certainty humans will repeat sequences of sounds and actions over and over. So, the more she asks the more I am certain my column is properly identified. I want my column to look at what we, as speech language pathologists do in our daily routines and ask, ‘why?’

I’m at that particular crossroad in my own professional and personal life. Why am I doing this work? Why am I working with this population? Why do I get up in the morning and drudge off from the home I love to spend a fair chunk of my waking hours in the service of strangers in somebody else’s sterile environment? Are these the why’s I want to be answering in ten years? What about twenty years? Dare I believe I have thirty years more to ask these questions?

So, what’s the frequency will be devoted to thoughts about what we do, what I do, and ask that simply impossible question: why?

About the author

Marguerite Mullaney was born and raised in and around the Boston area. She continues to make her home in the Commonweath and rarely finds it necessary to travel beyond the 128 belt. Her undergraduate program was completed at Bridgewater State College and she attended Northeastern University for graduate school. Adult neurological disorders has been the primary focus of her clinical practice. Her vast knowledge of the field, thoughtful, pragmatic approach and incredible sense of humor have enlightened and inspired her patients, staff and colleagues for over 20 years.

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Why we need to show up

Why we need to show up

By Lisa Yauch-Cadden

“Why we need to show up”

As we mentioned in our welcome to this website, Speech Language Pathology can be a profession of great joy, and great loneliness. Often, as sole practioners in schools, hospitals, rehab centers, medical/private offices, and home care settings, we may be the only source of speech and language services available to a child or adult in our community. I have personally worked in hospitals, with no out-patient treatment services, skilled nursing facilities with no/poor access to home care services, schools where families cannot afford additional services through out-patient clinics, and in out-patient settings, where support from the school system has been limited. I have also known clinicians who, all by themselves are the hospital based SLP, the homecare SLP, the school therapist and the out-patient provider. In these situations, we have a huge responsibility to our patients. We may be the only one to diagnose and treat a patient’s problem, or provide a family or physician with needed information. Yet, over the past several years, I have noticed more and more therapists, not taking these responsibilities so seriously.

I have known therapists to cancel appointments for convenience or to avoid a patient with behaviors, therapists that utilize the same treatment approach with multiple patients regardless of individual needs, and utilize the same treatment materials with the same patient, over and over, and then blame the patient when he/she doesn’t make progress. I have worked in facilities where staffing required multiple SLPs to service the same patient on different days, and because no single SLP felt responsibility for the patient, (they were “just covering”, after all), the patient failed to make progress. I have met with indignant therapists, astonished that a payor source would require accountability, prior to paying for services, and I have seen talented therapists leave the field, because they did not want to play by a new set of rules.

In all of these instances, I am reminded that, while as therapists, we think that Speech Language Pathology is about us – our skills, our expertise, our credentials. It is not. It is about the patient. Every client that crosses our path is referred to us, because someone who cares about that person has a question or a concern that needs to be addressed. Someone in that patient’s family, desperately wants them to get better, and often we are the only ones to whom they can turn. We cannot phone it in. We have to show up.

When Mrs. Jones sends her 3 year old autistic son to the school or the out-patient clinic, she is putting her baby in our hands, and hoping for progress. When the homecare clinician sends her patient for an MBS/FEES, she is looking for specific information on the nature of that patient’s dysphagia, as well as recommendations for intervention. When Mr. Smith, an 88 year old man enters the skilled nursing facility for rehab, he is relying on us to understand his Medicare benefit, and entrusting us get him the services he deserves. When we think it is beneath us to be told to provide 35 minutes of care or make sure that we see a patient on Thursday vs. Friday, or write a note that conveys an appropriate level of service, we only hurt the patient, and put them at risk for losing the services, to which they are entitled. And when we cover multiple facilities/multiple patients with multiple clinicians, we need to be responsible for our session, and advance the treatment plan. It is our responsibility to understand our patients’ problems and their payor source and provide skilled intervention to meet their goals.

Now, I know it is hard to bring your ‘A’ game every day, and there are lots of forces that conspire against us (family, kids, traffic, heavy caseloads, limited access to materials, uncaring bosses, budget cuts, etc.). Sometimes patients are needy and families are unrealistic, and our caseloads are unending, and on some days, we have to leave by 3:00 p.m., no questions asked, but we owe it to our patients to try our best, everyday, and honor the implied trust between us. If the situation were reversed, we would expect nothing less.

About the author

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com.

If you have something to say, please submit your article for consideration to lycslp@gmail.com.…

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Reflections on a Career in SLP

Reflections on a Career in SLP

By Therese M. O’Neil-Pirozzi, ScD, CCC-SLP

I doubt that there’s anyone who hasn’t been impacted by the January earthquake in Haiti –  maybe you lost someone who lived there…  maybe you spent some time volunteering there…  maybe you were touched by photos that you’ve seen or by articles that you’ve read…

I’ve been following the news about medical teams that have traveled to Haiti, and I’ve read about the minimal technology available to assist them in their provision of care to those in need.  Reasons for this include the limited technology in place before the earthquake because of the country’s economy and the fact that much of the technology that was previously available was destroyed by the earthquake.  Nonetheless, the injured are benefiting from quality care, and the health care providers ministering to them are expressing great pride and satisfaction with the work that they are doing

You don’t have to be providing care in a country that’s just experienced an earthquake to be challenged by limited resources trying to do so-  maybe you’re employed in a school system with no monies to purchase assessments…  maybe you work in a medical setting that doesn’t have easy access to videofluoroscopy or endoscopy…  maybe you volunteer at a homeless shelter where there’s no quiet space to empower parents to stimulate their children’s language literacy development…  Nonetheless, you minister to your students, clients, patients, and “new friends” effectively, with these people demonstrating positive outcomes as a result.

As part of Speech-Language Pathology coursework, many of us completed assignments in which we created our own articulation tests, our own auditory discrimination tests, and our own language intervention kits.  I remember painstakingly trying to draw pictures of common objects and 3-step activities and then showing them to young nieces and nephews to see if they could tell what they were supposed to be.  One of my undergraduate final exams was as follows:  “You and a 7-year old boy are in a room with a table, two chairs, and a window.  You have a pencil, a paper, and a piece of string.  Do a complete speech-language evaluation on this child.”  Although I was sure that that final was going to mark the end of my future as a speech-language pathologist, I passed the exam and continued on…

Since then, I have had to conduct countless diagnostic and therapeutic sessions without the benefit of valuable technology and other equipment and materials that I find useful.  And, in spite of the obvious challenges that this presents, I feel that these experiences have made me a better clinician.  With my eyes, ears, a deck of cards, a free newspaper, and some continually evolving critical thinking skills, I have figured out ways to do what needs to be done to benefit those with whom I am working.  Is it challenging doing this?  Yes!  Is it my preference to do things this way?  No!!  But, I think that the fundamental key to our effectiveness as clinicians is not the tools that are available for us to use with our students, clients, patients, and “new friends,” but, rather, our ability to learn how to problem solve evidence-supported ways to do what we need to do with whatever we do or do not have.

…You have a lollipop, a cup, and a phone bill.  Do a complete diagnostic evaluation on a 57-year old female with suspected cognitive-communication impairments…

Therese M. O’Neil-Pirozzi, ScD, CCC-SLP
t.oneil-pirozzi@neu.edu

About the author

Therese O’Neil-Pirozzi, ScD, CCC-SLP is the SLP Graduate Program Director and Associate Professor at Northeastern University in Boston, MA. She is also a Clinical Researcher and Clinician for Spaulding Rehabilitation Hospital. Author of many research articles, she is a frequent presenter at ASHA’s annual conventions. Her areas of interest crisscross from adults to children, from voice to aphasia, from dysphagia to literacy. If Speech Language Pathology ever had a renaissance clinician, then it would surely be Therese. In addition to her body of work, Therese continues to find time to be a resource to practicing clinicians, an advisor to graduate students, a good friend for those of us lucky enough to know her, and a devoted Red Sox fan. Her email address is: t.oneil-pirozzi@neu.edu

If you would like to reflect on your career in Speech Language Pathology/Audiology, please submit your article for consideration to mullaneycccslp@comcast.net.…

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My Guru

My Guru

By Matt Mullen

From the moment we are born a story is being told to us. Another way of saying this is that from the moment we are born, the world is being described to you by other people who have had it described to them, over and over, down through the ages. This description is neither good nor bad. It just is. This is fairly easy to see when one gives it any attention. However, something came before the story, that is your breath.

We enter this world on the inhale..we exit it on the exhale. Consider the power and potential in your breath. It is unique to you, you could say it’s your oldest friend, old reliable, never judging you, always looking out for you, even though we usually pay it little attention. It’s not jealous, however. Your breath stays loyal to you, far more loyal than your fickle, transitory thoughts. And the breath, when given a little love and attention will reward you with a treasure trove: calmness, expansion, peace. When we focus on our breath, we are reminded of our original voice, before the fleeting drama of the collective internal dialog began.

Our breath guides all of our bodily systems. The breath is the master regulator of these complex systems. The respiratory is an obvious one. However, the breath nourishes the cardiovascular, neurological, as well as the spiritual. Our bodies’ rhythm is set by this supreme conductor.  As you read these words are you thinking about your breath? Probably not. And yet, there it is, undivided, life giving.

If we consider that our world has been described to us, you could say that description is a type of division, a way of sorting things out to make sense of our reality. The ancient practice of Yoga reminds us that we are actually undivided. In fact, for all the millions of words written about Yoga, it’s simple definition is a union, to bring together, to yoke together. Breath is the very thing that brings us together, binding us as sentient beings. The breath IS yoga. The breath is whole, complete. Can the mind grasp this wholeness? Careful, it’s a trick question! To answer yes or no is to come from that very place of division. The mind considers the question. The breath moves through the question, unconcerned with contrasts and comparisons.

So, we can see that the breath is ever present, and thoughts are ever fleeting. Meditating on this simple fact is enough to soothe and quiet the mind. Please consider, when we speak about meditation we are not speaking about something that is a chore. Indeed, meditation is your natural sanctuary.

As we conclude this article, try this:

Sitting right where you are. Take a deep breath through your nose. Fill up! Gently hold the breath at the top of the inhale, slowly exhale, completely, also through the nose. Resume your natural breath. After a few moments. Try it again. This time think of your exhale like a faucet. Increase, or decrease the volume of your exhale, like you would a water faucet.
Observe how you feel. No judgement, just observe.

Thoughts imagine the present moment. Breath experiences it directly.

Enjoy the simple power of your breath. It’s truly yours, unique to you. Your oldest, most faithful friend!

Peace,  Matt Mullen

About the author

Matt Mullen is a massage therapist, yoga instructor, healthy living coach, father, friend, educator, and student of the universe. Along his journey he’s learned a little, but it was enough for him to realize that the questions are often much more important than the answers men conjure up to explain the unexplainable. Matt is available for consultations and individual appointments. Please contact him directly at maudeml@yahoo.com

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